Children’s expert pushes for concussion safety

When a child athlete gets a head injury during a game it’s a scary moment for everyone. After the downed player gets back on his or her feet the sense of relief is tangible. And when the still-woozy player jumps right back into position, the support from the sidelines can border on electric. Comments on the player’s “toughness” or abundance of “heart” are often made, sometimes shouted above the applause and cheers of the approving crowd. This attitude is supported in professional sports where concussions are often mentioned in the same breath as “back spasms” in terms of severity.

Yet, the more doctors and researchers learn about concussions the more they realize that players who immediately return to the game after a head injury (and the coaches who sanction it) are engaging in very risky behavior. Brain injuries, including concussions, can cause serious cognitive and neurological damage and can even be fatal. Kids who suffer a concussion are also more vulnerable to suffer a second one, especially if they’re roughed up before the original injury has fully healed. Repeated concussions suffered over the course of a few days or weeks can compound the neurological damage and greatly increase the chance of permanent brain damage or death.

According to the most recent data from the Centers for Disease Control, 135,000 kids aged 5 to 18 are treated at emergency rooms every year for sports related head injuries, including concussions.

To combat the growing number of concussion-related medical complications suffered by youth athletes, new legislation has gone before Massachusetts lawmakers that would make concussion education a requirement for all athletes who participate on public school teams, as well as parent volunteers, school medical personnel and coaches. The bill would also require a physician’s examination and approval before a child is permitted to return to play if he or she loses consciousness after an incident on the field, court or rink.

Mark Proctor, MD

“Legislation requiring mandatory doctor approval before letting a player back in the game after a head injury takes some of the stigma away from sitting out,” says Mark Proctor, MD of Children’s Hospital Boston’s Department of Neurosurgery who contributed to the wording of the bill. “Traditionally it’s been somewhat of a badge of honor to get your bell rung in football or hockey and then keep playing. It’s often looked at as a good thing by the athlete, who is eager to return to play, but in reality it’s not a good thing at all.”

Proctor says the lack of immediate physical evidence that a player has suffered a concussion makes head injuries tough to diagnose without a proper medical examination.

“Unlike something like a broken arm— where just by looking at it you can get an idea of the severity of the injury— brain injuries are harder to detect right after they happen,” he says. “Most young athletes recover from concussions quickly and are fine, but those who don’t and keep playing run the risk of compounding the injury and making it worse. Concussions are mild brain injuries, and brain injuries should never be taken lightly.”

Because of their potential for serious long-term consequences, Proctor suggests parents, coaches and teammates view all head injuries as serious, especially if the hurt player is experiencing nausea, dizziness, sleepiness or seems confused after the hit. “[These] are signs of a concussion or a more serious brain injury and should be investigated immediately,” he says. Proctor also notes that when it comes to brain injury it’s better to overreact than downplay the injury. The mentality that a young athlete can “wait out” a head injury by sitting out for a few minutes or staying awake that night has too much potential for devastating long term effects. “If you’re at the point where you’re worried about the child falling asleep you should seek medical attention,” he says.

For more information on the devastating impact of a concussion, please read the story of a Children’s patient who went from a straight “A” student to an isolated teen who wouldn’t leave her darkened room.

Lots of stories about concussions lately. It’s great awareness-building. My preference is to get athletic programs to require a pre-season competence exam (as baseline) that gets retaken after a concussion to assess injury and recovery. There is a company that provides this service and it came out to